Diabetes Type IPathophysiology of insulin deficiency

Clinical Manifestations: Diabetes

EARLY SYMPTOMS

PolyuriaPolydipsiaPolyphagiaVisual blurringFatigueWeight loss

LATE SIGNS AND SYMPTOMS

ComaChronic complications

Potassium Replacement in Diabetic Ketoacidosis

In clients with adequate urine output, lead II of the 12-lead electrocardiogram may be used as a guide for plasma potassium (K+) concentration. Flattening or inversion of

the T wave with U wave and prolongation of the QT interval indicate hypokalemia. Peaking of T waves, loss of P wave, and a disrupted QRS complex indicate hyperkalemia.

Intravenous replacement of potassium is based on plasma K+ concentration. If K+ concentration is:

<3 mEq/L, infuse 0.6 mEq/kg/hr 3—4 mEq/L, infuse 0.6 mEq/kg/hr 4—5 mEq/L, infuse 0.2—0.4 mEq/kg/hr 6 mEq/L, withhold until K+ concentration is <6.0 mEq/L

Add K+ to replacement fluid therapy. If concentration is 20—40 mEq/L and infusion into peripheral vein causes irritation, infuse into central vein.

Recheck plasma K+ concentration every 2 hours if previous value was <4 or >6 mEq/L.

The glucose continuum

Numbers represent blood glucose levels in mg/dl.The pathophysiology of diabetic ketoacidosis

Pathophysiology of insulin deficiency

Intervention Activities for The Diabetic Client Experiencing or at Risk for Hypoglycemia

Hypoglycemia Management: Preventing and treating low blood glucose levels

Identify client at risk for hypoglycemia. Monitor blood glucose levels, as indicated. Monitor for signs and symptoms of hypoglycemia (e.g., shakiness, tremor,

sweating, nervousness, anxiety, irritability, impatience, tachycardia, palpitations, chills, clamminess, light-headedness, pallor, hunger, nausea, headache, tiredness, drowsiness, weakness, warmth, dizziness, faintness, blurred vision, nightmares, crying out in sleep, paresthesias, difficulty concentrating, difficulty speaking, incoordination, behavior change, confusion, coma, seizure).

Provide simple carbohydrate, as indicated. Provide complex carbohydrate and protein, as indicated. Administer glucagon, as indicated. Contact emergency medical services, as necessary. Administer intravenous glucose, as indicated. Maintain patent airway, as necessary. Maintain IV access, as appropriate. Protect from injury, as necessary. Review events prior to hypoglycemia to determine probable cause.

Provide feedback regarding appropriateness of self-care management of hypoglycemia.

Instruct client and significant others on signs and symptoms, risk factors, and treatment of hypoglycemia.

Instruct client to have simple carbohydrates available at all times. Instruct client to obtain and carry/wear appropriate emergency identification. Instruct significant others on the use and administration of glucagon, as

appropriate. Instruct on interaction of diet, insulin/oral agents, and exercise. Provide assistance in making self-care decisions to prevent hypoglycemia

(e.g., reducing insulin/oral agents and/or increasing food intake for exercise). Encourage self-monitoring of blood glucose levels. Encourage ongoing telephone contact with diabetes care team for

consultation regarding adjustments in treatment regimen.

Common insulin injection sites

Time Activity of Pharmaceutical InsulinDifferentiation of Hypoglycemia and Hyperglycemia

DKA, Diabetic ketoacidosis.

Intervention Activities for The Diabetic Client Experiencing or at Risk for Hypoglycemia

Hypoglycemia Management: Preventing and treating low blood glucose levels

Identify client at risk for hypoglycemia. Monitor blood glucose levels, as indicated. Monitor for signs and symptoms of hypoglycemia (e.g., shakiness, tremor,

sweating, nervousness, anxiety, irritability, impatience, tachycardia, palpitations, chills, clamminess, light-headedness, pallor, hunger, nausea, headache, tiredness, drowsiness, weakness, warmth, dizziness, faintness, blurred vision, nightmares, crying out in sleep, paresthesias, difficulty concentrating, difficulty speaking, incoordination, behavior change, confusion, coma, seizure).

Provide simple carbohydrate, as indicated. Provide complex carbohydrate and protein, as indicated. Administer glucagon, as indicated. Contact emergency medical services, as necessary. Administer intravenous glucose, as indicated. Maintain patent airway, as necessary. Maintain IV access, as appropriate. Protect from injury, as necessary. Review events prior to hypoglycemia to determine probable cause. Provide feedback regarding appropriateness of self-care management of

hypoglycemia. Instruct client and significant others on signs and symptoms, risk factors, and

treatment of hypoglycemia. Instruct client to have simple carbohydrates available at all times. Instruct client to obtain and carry/wear appropriate emergency identification. Instruct significant others on the use and administration of glucagon, as

appropriate. Instruct on interaction of diet, insulin/oral agents, and exercise. Provide assistance in making self-care decisions to prevent hypoglycemia

(e.g., reducing insulin/oral agents and/or increasing food intake for exercise). Encourage self-monitoring of blood glucose levels. Encourage ongoing telephone contact with diabetes care team for

consultation regarding adjustments in treatment regimen.

Symptoms of Hypoglycemia

Characteristics of Type 1 and Type 2 Diabetes Mellitus

Activities That Affect Caloric Expenditure

Patient & Family Teaching Guide: Exercise for Patients with Diabetes Mellitus

Interventions for Hypoglycemia

Three blood glucose phenomena in diabetic clients

Blood Glucose Values

Genetic Considerations

Risk for type 1 diabetes is determined by inheritance of the HLA-DR3 and HLA-DR4 genes. However, although inheritance of these genes increases the risk, most people with these genes do not develop type 1 diabetes. Development of the disease is an interactive effect of genetic predisposition and exposure to certain environmental factors. The risk for type 1 diabetes in the general population ranges from 1 in 400 to 1 in 1000. The risk greatly increases for those who have at least one parent with diabetes (from 1 in 20 to 1 in 50) (Franz, 2001). It is unclear why some genetically susceptible people develop diabetes and others do not.

Differences Between Diabetic Ketoacidosis and Hyperglycemic-Hyperosmolar State

Diabetes Type I

The pathophysiologic mechanism of diabetic ketoacidosis.

Features of Diabetic Neuropathy

Client Education Guide: Foot Care Instructions Inspect your feet daily, especially the area between the toes. Wash your feet daily with lukewarm water and soap. Dry thoroughly. Apply moisturizing cream to your feet after bathing. Do not apply to the area

between your toes. Change into clean cotton socks every day. Do not wear the same pair of shoes 2 days in a row, and wear only leather

shoes. Check your shoes for foreign objects (nails, pebbles) before putting them on.

Check inside the shoes for cracks or tears in the lining. Purchase shoes that have plenty of room for your toes. Buy shoes later in the

day, when feet are normally larger. Break in new shoes gradually. Wear socks to keep your feet warm. Trim your nails straight across with a nail clipper. Smooth the nails with an

emery board. See your physician or nurse immediately if you have blisters, sores, or

infections. Protect area with a dry, sterile dressing. Do not use adhesive tape to secure dressing.

Do not treat blisters, sores, or infections with home remedies. Do not smoke. Do not step into the bathtub without checking the temperature of the water

with your wrist. Optimal temperature is 95° F (29.4° to 35° C). Do not use very hot or cold water. Never use hot water bottles, heating pads,

or portable heaters to warm your feet.

Do not treat corns, blisters, bunions, calluses, or ingrown toenails yourself. Do not go barefooted. Do not wear sandals with open toes or straps between the toes. Do not cross your legs or wear garters or tight stockings that constrict blood

flow. Do not soak your feet.

Features of Diabetic Neuropathy

Prevention, Detection, and Monitoring of Long-Term Complication of Diabetes Mellitus

Outcome Criteria for Diabetic Teaching